Fast Care Research Articles

Assessment of Patient Handover Process from Operating Room to Intensive Care Unit at Cardiovascular Surgery Hospital of Ain Shams University

Abstract Background Handovers of post-anesthesia patients to the intensive care unit are commonly unstructured and performed under time pressure. The cardiovascular patients are transferred directly to intensive care unit after the operation, as these vulnerable patients need more and faster care. Therefore, the handover processes are more susceptible to poor communication, loss of information and potential patient harm. Objective To identify the frequency of defects of current practice of healthcare providers during handover process from operating room to ICU after cardiovascular surgery and to determine the contributing factors that affect the transition of care process. Methods This descriptive Cross-sectional study was conducted after cardiovascular surgery the intensive care unit of Cardiovascular Surgery Hospital, one of Ain Shams University Hospitals between December 2021 to March 2022. A checklist was used to assess the performance of handover processes of 120 adult patients after cardiovascular operation, which included 8 main areas (Contributing factor, Pre-handover, Equipment and technology handover, Patient specific information, Anesthesia information, Surgical information, Duration of handover process, Distraction) Results The mean age of patients was 56.03 ± 10.77 years and most of them 85 (70.8%) were males. The median number of errors in pre-handover process was 0(0), patient specific information 3(1), anesthesia information 3(0), surgical information 4.5(2) and equipment handover 3(0). The mean duration of handover processes in minutes was 15.09 ± 5.69 (range 8–35) and 76 (63.3%) of the processes had distractions. There was no significant correlation between age, duration of surgery, duration of handover and number of errors regarding (pre- handover, patient information, anesthesia information, surgical information and equipment handover).The important items were not handed over at all(name of the patient, allergies to medication, estimated blood loss, medications given during surgery which need to be restarted) Conclusions and Recommendations The overall omission is low in spite of the expected to be zero, taking into consideration the type of procedures and the patient condition, so the critical situation need every elements must be fulfilled for patient safety and to avoid complications that may threat the patient life.

Penerapan Metode Certainty Factor Dalam Mendiagnosa Penyakit Otitis Eksterna

Otitis externa is a common ear problem that often requires an accurate diagnosis for effective treatment. The Certainty Factor Method is an artificial intelligence approach used to support the diagnostic process. This research aims to apply the Certainty Factor Method in diagnosing otitis externa. Patient data, including symptoms, medical history, and examination results, are used to build a knowledge base that is then utilized in the diagnostic process. This method allows for improved accuracy in determining diagnoses by considering the confidence level associated with each symptom and examination result. Experimental results show that the application of the Certainty Factor Method can assist doctors in diagnosing otitis externa with higher accuracy compared to conventional methods. With this approach, diagnoses are made with higher confidence levels, which can aid in providing accurate and prompt treatment for patients suffering from otitis externa. The Certainty Factor Method has the potential for use in other medical contexts and can make a positive contribution to problem-solving in the healthcare field. This research underscores the importance of technology in supporting ear disease diagnosis and providing more reliable solutions for managing otitis externa. By leveraging the Certainty Factor approach, doctors can be more efficient and effective in responding to patients' conditions, thus reducing the risk of complications and enhancing healthcare quality. Therefore, this study offers a valuable contribution to the fields of medicine and computer science in improving the diagnosis of ear diseases, such as otitis externa, so that patients can receive better and faster care.

Mobile application for the control process of childhood anemia in time of the pandemic

The objective of the research was to implement a mobile application for the control process of childhood anemia in times of pandemic, in order to have better medical control with faster care, better control of the diagnosis of anemia in children, and better performance and satisfaction. The following Scrum method was applied. The research has a quantitative approach, of experimental type. The sample consisted of 40 children. Results were obtained regarding time control in the speed of care, an increase of 10.2% was obtained; regarding the number of diagnoses, control, and follow-up in recovery there was an increase of 33.3% and finally regarding the control of performance and satisfaction with care there was an increase of 73.3%.

Time to Care: Analysis of Time Differences and Outcomes in the Management of Pediatric Traumatic Brain Injury for a High-Income and Lower-Middle-Income Country

Pediatric cranial trauma is the leading cause of acquired death and disability in children worldwide. However, trauma resources vary widely among countries. We sought to compare management and timely access to care between a level 1 U.S. pediatric trauma center and a tertiary referral hospital in a lower-middle-income country to assess whether system and resource differences influence care and outcomes. We compared data from 214 pediatric head trauma admissions to Philippine General Hospital (Manila) with 136 children from the TRACK-TBI pediatrics study cohort at Massachusetts General Hospital (MGH). Admitted MGH patients were compared with the Philippine cohort regarding demographics; mechanism of injury; times to neurosurgical consult, imaging, and surgery; in-hospital mortality; and length of hospitalization. Age (9 years), gender distribution (67% male), and presenting Glasgow Coma Scale scores were similar (P= 0.10) between sites. More children had intracranial injury in the Philippine cohort (73% vs. 60%; n= 319) and more underwent neurosurgery (27% vs. 4%). Times to consult, imaging, and surgery were longer in the Philippines (12.3 vs. 6.5, 12.0 vs. 2.8, and 45.4 vs. 5.6 hours, respectively). In-hospital mortality across all admissions was similar between cohorts (3% vs. 0%; P= 0.09), but significantly higher in the most severe Philippines cases (31% vs. 0%, P=0.04). Length of stay was longer (5 vs. 2 days; P < 0.001) in the Philippine cohort. High-income country status correlated with faster care, shorter hospitalizations, and better outcomes among severe cases. Prompt care through sophisticated trauma system implementation may improve pediatric health in resource-limited settings.

Sustaining a New Model of Acute Stroke Care: A Mixed-Method Process Evaluation of the Melbourne Mobile Stroke Unit.

Internationally, Mobile Stroke Unit (MSU) ambulances have changed pre-hospital acute stroke care delivery. MSU clinical and cost-effectiveness studies are emerging, but little is known about important factors for achieving sustainability of this innovative model of care. Mixed-methods study from the Melbourne MSU (operational since November 2017) process evaluation. Participant purposive sampling included clinical, operational and executive/management representatives from Ambulance Victoria (AV) (emergency medical service provider), the MSU clinical team, and receiving hospitals. Sustainability was defined as ongoing MSU operations, including MSU workforce and future model considerations. Theoretically-based on-line survey with Unified Theory of Acceptance and Use of Technology (UTAUT), Self Determination Theory (SDT, Intrinsic Motivation), and open-text questions targeting barriers and benefits was administered (June-September 2019). Individual/group interviews were conducted, eliciting improvement suggestions and requirements for ongoing use. Descriptive and regression analyses (quantitative data) and directed content and thematic analysis (open text and interview data) were conducted. There were 135 surveys completed. Identifying that the MSU was beneficial to daily work (β=0.61), not experiencing pressure/tension about working on the MSU (β=0.17) and thinking they did well working within the team model (β=0.17) were significantly associated with wanting to continue working within the MSU model [R2=0.76; F(15, 60)=12.76, P<.001]. Experiences varied between those on the MSU team and those working with the MSU. Advantages were identified for patients (better, faster care) and clinicians (interdisciplinary learning). Disadvantages included challenges integrating into established systems, and establishing working relationships. Themes identified from 35 interviews were MSU team composition, MSU vehicle design and layout, personnel recruitment and rostering, communication improvements between organisations, telemedicine options, MSU operations and dispatch specificity. Important factors affecting the sustainability of the MSU model of stroke care emerged. A cohesive team approach, with identifiable benefits and good communication between participating organisations is important for clinical and operational sustainability.

Enhanced Recovery after Surgery (ERAS) for Hip and Knee Replacement-Why and How It Should Be Implemented Following the COVID-19 Pandemic.

The COVID-19 pandemic has led to a reduction in hip and knee replacement surgery across healthcare systems. When regular operating returns, there will be a large volume of patients and an emphasis on a short hospital stay. Patients will be keen to return home, and capacity will need to maximised. Strategies to reduce the associated risks of surgery and to accelerate recovery will be needed, and so Enhanced Recovery after Surgery (ERAS) should be promoted as the model of care. ERAS protocols are proven to reduce hospital stay safely; however, ERAS pathways may require adaption to ensure both patient and staff safety. The risk of exposure to possible sources of COVID-19 should be limited, and so hospital visits should be minimised. The use of technology such as smartphone apps to provide pre-operative education, wearable activity trackers to assist with rehabilitation, and the use of telemedicine to complete outpatient appointments may be utilised. Also, units should be reminded that ERAS protocols are multi-modal, and every component is vital to minimise the surgical stress response. The focus should be on providing better and not just faster care. Units should learn from the past in order to expedite the implementation of or adaption of existing ERAS protocols. Strong leadership will be required, along with a supportive organisational culture, an inter-professional approach, and a recognised QI method should be used to contextualize improvement efforts.

Tomorrow's hospital: how technology will be transforming both inpatient and at-home care.

The hospital of the future will work much more quickly and efficiently to provide better and faster care. From emergency room visits to surgery to hospital stays to outpatient care, the coming hospital will seamlessly integrate high-tech systems to improve patient outcomes. Doctors, nurses, pharmacists and other clinicians will be able to easily confer and communicate. That future may not be here yet, but it will be soon.

MOBILE CLOUD COMPUTING FRAMEWORK FOR PATIENTS' HEALTH DATA ANALYSIS

The advent of cloud computing and the ubiquity of broadband wireless coverage and wide spread usage of smart phones around the world carries the potential for transforming health care services, reducing health care cost and ensuring faster care for urgent cases. To these objectives, we present a cloud-based mobile health monitoring solution that takes advantage of cloud infrastructure and mobile processing capability to address the rising cost of health care monitoring. The solution enables health care providers to remotely analyze, monitor and diagnose patient's data. The solution integrates a powerful data analysis tool, cloud computing and mobile services. This paper presents a proof of concept that has been developed to monitor, record and analyze heart rate. The design enables a physician to develop custom analysis and monitoring to collect key indicator or set alerts without a need for infrastructure implementations to store or transfer the data.

VITAL SIGNS REMOTE MONITORING AND ANALYSIS: SEAMLESS INTEGRATION WITH A SMART PHONE

The ubiquity of broadband wireless coverage and widespread usage of smart phones around the world carry a potential for transforming health care services, reducing health care cost, and ensuring faster care for urgent cases. To these objectives, we present a mobile-based health monitoring solution that takes advantage of the mobile's increasing processing capability to address the rising cost of health care. The solution enables health care providers to easily analyze and diagnose a patient's data. This is possible due to the low cost in integrating a powerful data analysis tool with the mobile device. This paper presents a proof of concept that has been developed to monitor, record, and analyze the heart rate. The design enables a physician to develop custom analysis and monitoring to collect key indicators or set alerts without a need for infrastructure implementations to store or transfer the data.

Néphrectomies réalisées dans un contexte d’urgence : étude rétrospective, monocentrique à propos de huit cas

Emergency nephrectomies are rare because of the improvement of the management of urinary tract infections and the development of radio-embolization. Few series of patients have been reported. The objective of our study is to assess the indication, the morbi-mortality and the outcome of the emergency nephrectomy performed in our hospital. Between January 2011 and November 2012, eight patients underwent an emergency nephrectomy at the University Hospital Center of Caen. The present review reports the characteristics of this emergency nephrectomy and their morbi-mortality. Six women and two men were analyzed retrospectively between January 2011 and November 2012. All patients except one needed intensive care for a multiple-organ failure. All these eight emergency nephrectomies concerned a native kidney with a surgical approach as a lombotomy or subcostal laparotomy. Both patients survived. One patient need a renal dialysis support. Emergency nephrectomy are rare. Uncontrolled urinary sepsis represents the main indication. Identifying the population at risk of evolution to the toxic shock is indispensable for a better and faster care and to reduce the mortality bound to the sepsis.

Improving timeliness while improving the quality of emergency department care

Increased ED waiting times, increased ED length of stay and their association with adverse events, including mortality, have refocused government policy on time targets. Time-based performance targets for emergency medicine were highlighted as a potentially useful strategy in the mid 1990s in Victoria with the Emergency Services Enhancement Program, when bonus payments were shown to improve patient access. In the UK, reform of the National Health Service (NHS) included implementation of the 4 h standard or target in 2004, with Western Australia (WA) and New Zealand following suit in 2009. The original intent was that 98% of patients would be seen, admitted, discharged or transferred from ED within 4 h. This was soon revised to 95% in the UK and 85% of presentations in WA. In contrast, the New Zealand Shorter Stays in EDs (SSEDs) target was set at ‘95% in six hours’, following advice from local clinicians and nurses, with the belief that 6 h was ‘long enough for good clinical care but not unjustifiably long’. Evaluation of the NHS targets suggests that they have been successful in reducing long waits in the ED. Significantly, UK emergency physicians describe the major benefit of the target as enforcement of a ‘whole of system’ change without focus on the ED performance in isolation. However, there are conflicting reports on associated clinical outcomes, with concerns about the potential for a fixation on meeting the time standards to the detriment of the quality of patient care. It is notable the new British government responded to these fears by modifying the standard in 2011 to include a suite of eight clinical quality indicators (CQIs) that were designed to focus on timeliness along with the quality of clinical care and the patient experience. In Australia, the impact of time targets on improving the quality of care is unclear, with the Stokes report from WA suggesting need for further study and further monitoring. Initial research has suggested a possible reduction in mortality since the introduction of the 4 h rule in WA; however, methodological issues, including the lack of long-term trends, limit any conclusions at this stage. Introduction of mandatory reporting of CQIs potentially results in a more balanced approach to patient care. As such, the danger of only achieving faster care should be reduced. CQIs need to encompass measures of clinical outcomes, clinical effectiveness, safety and service experience, as well as timeliness. In doing so, they align with the Institute of Medicine’s Quality Care framework of effectiveness, safety, timeliness, patient/ family centredness, access and efficiency. CQIs should also support a culture of continuous improvement in the quality of care; however, this can only be achieved with ongoing monitoring and regular audit, alongside feedback and implementation strategies – which is not explicit in the introduction of these indicators. In this issue of Emergency Medicine Australasia, Jones et al. report on a comprehensive process to develop a set of evidence-based and clinically and locally relevant quality of care indicators for New Zealand. Indicators were initially selected following review of the existing international literature with feedback from the New Zealand emergency healthcare community. This was followed by subsequent validation by a multidisciplinary reference group. The reference group was representative of the wider health system

Triage of minor burn wounds: avoiding the emergency department.

Many patients with minor burn wounds will initially be evaluated in an emergency department (ED) and incur unnecessary costs that could be avoided through a direct referral to a burn center. In June 1997, use of an ED burn triage protocol was begun at our hospital. Adults with uncomplicated burns that covered more than 1% and less than 15% of total body surface area (TBSA) and children with burns that covered more than 1% and less than 10% of TBSA were to be triaged directly to the outpatient clinic of the burn center without registering in the ED. From 1996 to 1997, 653 patients were seen in the ED for burn injuries. Approximately 500 patients fit the present criteria for direct triage to the burn center. Since the triage protocol began, the percentage of patients triaged to the burn center has increased from 27% in the first month of use (July 1997) to 73% in December 1997. At least 33% of ED patients were eligible by protocol but not triaged. The average ED visit time for these patients was 103 minutes versus 44 minutes for patients who were sent directly to the burn clinic. An estimated $125,000 per year decrease in charges would occur with use of the protocol. Implementation of an ED triage protocol leads to avoidance of emergency room visits for the majority of patients with minor burn injuries, which results in more efficient, less expensive, faster care.

Shopping Around for Hospital Services. A Comparison of the United States and Canada

Context.—Historical comparisons indicate that US hospitals are more expensive than Canadian hospitals, but health care system reform might have changed the relative costs and timeliness of health care in the 2 countries.Objective.—To estimate the price and convenience of selected hospital services in the United States and Canada for patients in 1997 had they paid out-of-pocket.Design.—Cross-sectional telephone survey conducted May 1996 to April 1997.Participants.—The 2 largest acute care general hospitals from every city in the United States and Canada with a population greater than 500000.Measures.—Each hospital was telephoned and asked their price and waiting time for 7 services: magnetic resonance imaging of the head without gadolinium; a screening mammogram; a 12-lead electrocardiogram; a prothrombin time measurement; a session of hemodialysis; a screening colonoscopy; and a total knee replacement. Waiting times were measured in days until earliest appointment and charges were converted to American currency.Results.—Overall, 48 US and 18 Canadian hospitals were surveyed. Median waiting times were significantly shorter in American hospitals for 4 services, particularly a magnetic resonance imaging of the head (3 days vs 150 days; P<.001). Median charges were significantly higher in American hospitals for 6 services, particularly for a total knee replacement ($26805 vs $10651; P<.001). Individual services showed no association between shorter waiting times and higher prices within each country, with the exception of a total knee replacement in the United States.Conclusion.—US hospitals still provide higher prices and faster care than Canadian hospitals for patients who pay out-of-pocket.